What I Didn ’t See
I saw (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Femoral Artery Dissection after Adductor Canal Block
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Understanding the Effects of General Anesthetics on Cortical Network Activity Using Ex Vivo Preparations
General anesthetics have been used to ablate consciousness during surgery for more than 150 yr. Despite significant advances in our understanding of their molecular-level pharmacologic effects, comparatively little is known about how anesthetics alter brain dynamics to cause unconsciousness. Consequently, while anesthesia practice is now routine and safe, there are many vagaries that remain unexplained. In this paper, the authors review the evidence that cortical network activity is particularly sensitive to general anesthetics, and suggest that disruption to communication in, and/or among, cortical brain regions is a comm...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Focused Cardiac Ultrasound during Amniotic Fluid Embolism
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries
This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery.Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or pro...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Fibrin Sheath Formation during Mechanical Circulatory Support Another Reason for Transesophageal Echocardiographic Monitoring
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Failure to Debrief after Critical Events in Anesthesia Is Associated with Failures in Communication during the Event
Conclusions Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Extrafasicular and Intraperineural, but No Endoneural, Spread after Deliberate Intraneural Injections in a Cadaveric Study
Conclusions After deliberate intraneural injection, longitudinal and circumferential extrafascicular spread occurred in all instances in the neural compartments that contained adipocytes, but not in the relatively solid endoneurium of the fascicles. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Opioid Sensitivity in Children with and without Obstructive Sleep Apnea
Conclusions No differences in the remifentanil concentration –miosis relation were seen in children with or without obstructive sleep apnea. The dose and duration of remifentanil administered did not alter ventilatory parameters in either group. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures A Randomized Controlled Trial
Editor ’s PerspectiveWhat We Already Know about This TopicDental procedures under sedation can cause hypoxic events and even death. However, the mechanism of such hypoxic events is not well understood.What This Article Tells Us That Is NewApnea and hypopnea occur frequently during dental procedures under sedation. The majority of the events are not detectable with pulse oximetry. Insertion of a nasal tube with small diameter does not reduce the incidence of apnea/hypopnea.Background Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypo...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery A Randomized Controlled Trial
Conclusions Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia
This study tested the hypothesis that rapid eye movement sleep disturbances would be present in ad olescent rats treated with anesthesia on postnatal day 7.Methods Forty-four neonatal rats were randomly allocated to treatment with anesthesia consisting of midazolam, nitrous oxide, and isoflurane or control conditions for 2  h or 6 h. Electroencephalographic and electromyographic electrodes were implanted and recordings obtained between postnatal days 26 and 34. The primary outcome was time spent in rapid eye movement sleep. Data were analyzed using two-tailed unpairedt tests and two-way repeated measures anal...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Machine Learning for Anesthesiologists: A Primer: Erratum
In the infographic “Machine Learning for Anesthesiologists: A Primer” (Wanderer JP, Rathmell JP:Anesthesiology 2018; 129:A29) from the October 2018 issue of Anesthesiology, references 3 and 4 should be switched. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia: Erratum
In the article “Disruption of Rapid Eye Movement Sleep Homeostasis in Adolescent Rats after Neonatal Anesthesia” (Lunardi N, Sica R, Atluri N, Salvati KA, Keller C, Beenhakker MP, Goodkin HP, Zuo Z: Anesthesiology 2019; 130:981 –94), the figure 2 image and legend were incorrect. They should have appeared as follows: (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

If We Don ’t Learn from Our Critical Events, We’re Likely to Relive Them Debriefing Should Be the Norm
“…[I]nterdisciplinary team de-briefings, including members ofall involved role groups, is an essential step toward narrowing the patient safety gap that still remains... ” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Dynamic Cortical Connectivity during General Anesthesia in Healthy Volunteers
Editor ’s PerspectiveWhat We Already Know about This TopicAnesthetic-induced loss of consciousness is accompanied by changes in functional connectivity within and between brain networks.What This Article Tells Us That Is NewDespite a stable surgical level of anesthesia and the absence of noxious stimuli, connectivity patterns are not static but rather fluctuate dynamically and nonrandomly over time. These results suggest that single or static connectivity patterns may not be able to discriminate levels of consciousness.Background Recent studies of anesthetic-induced unconsciousness in healthy volunteers have focused ...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Pediatric Risk Stratification Is Improved by Integrating Both Patient Comorbidities and Intrinsic Surgical Risk
In this study, the authors used the American College of Surgeons National Surgical Quality Improvement Program Pediatric database to demonstrate the relationship between the intrinsic surgical risk and 30-day mortality and develop and validate an accessible risk stratification model that includes the surgical procedures in addition to the patient comorbidities and physical status.Methods A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program Pediatric database was performed. The incidence of 30-day mortality was the primary outcome. Surgical Current Procedural Terminology...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Dynamic Cortical Connectivity during General Anesthesia in Surgical Patients
Editor ’s PerspectiveWhat We Already Know about This TopicAnimal data, along with recent human observations (in this issue ofAnesthesiology*), suggest that cortical oscillations and connectivity shift dynamically during what appears to be stable general anesthesiaClinical evidence in the perioperative setting to support these observations is currently lackingWhat This Article Tells Us That Is NewDuring anesthesia and surgery, cortical networks display a dynamic interplay among brain states, rather than a static equilibriumThese findings suggest that a single measure of connectivity may not be a reliable correlate of ...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Syncopated Tempi of the Anesthetized Brain
“…[C]ompare the function of the conscious brain to that of an orchestra making music.” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Breathing under Anesthesia A Key Role for the Retrotrapezoid Nucleus Revealed by Conditional Phox2b Mutant Mice
Editor ’s PerspectiveWhat We Already Know about This TopicMany if not all drugs used in anesthesia and analgesia can produce potentially severe respiratory depressionMaintenance of breathing under anesthesia is linked to the drive exerted by the retrotrapezoid nucleus on the respiratory central pattern generatorThe retrotrapezoid nucleus neurons that stimulate breathing during anesthesia are carbon dioxide –sensitive noncatecholaminergic neurons that expressPhox2b, a master gene for the development of autonomic neuronsThe conditional mouse model with the +7Ala repeat mutation targeted to the retrotrapezoid nucl...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

General Anesthesia for Cesarean Delivery Occasionally Essential but Best Avoided
“…[I]n the absence of contraindications, neuraxial anesthesia has been and remains the gold standard anesthetic for cesarean delivery.” (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Respiratory Physiology for the Anesthesiologist
We present the actions of pressure, flow, and volume as the normal determinants of ventilation, and we review the resulting abnormalities in terms of changes of resistance and compliance. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Activating α4β2 Nicotinic Acetylcholine Receptors Alleviates Fentanyl-induced Respiratory Depression in Rats
Editor ’s PerspectiveWhat We Already Know about This TopicOpioid-induced respiratory depression results in part from direct activation of μ-opioid receptors expressed in the inspiratory rhythm generator located in the ventrolateral medulla, the preBötzinger ComplexRespiratory neurons within the medulla also express nicotinic acetylcholine receptors, which are made up of five subunits, arranged symmetrically around a central poreActivation of the nicotinic acetylcholine receptor α4, α7, and β2 subunits increases respiratory rhythm, whereas activation of the nicotinic acetylcholine receptor &al...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Primum Non Nocere
I no longer remember his face yet (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Increased Reactivity of the Mesolimbic Reward System after Ketamine Injection in Patients with Treatment-resistant Major Depressive Disorder
Conclusions Single bolus ketamine administration rapidly triggers lasting changes in mesolimbic neural networks to improve pathologic reward and emotional processing in patients with major depressive disorder. (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Changes in Whole Brain Dynamics and Connectivity Patterns during Sevoflurane- and Propofol-induced Unconsciousness Identified by Functional Magnetic Resonance Imaging
Editor ’s PerspectiveWhat We Already Know about This TopicThe extent to which alterations within specific brain networks impairs communication among networks remains unknownWhat This Article Tells Us That Is NewIn a volunteer functional magnetic resonance study, general anesthesia reduced activity within and among networksSpecific between-network connectivity is necessary for consciousnessBackground A key feature of the human brain is its capability to adapt flexibly to changing external stimuli. This capability can be eliminated by general anesthesia, a state characterized by unresponsiveness, amnesia, and (most lik...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

This Month in Anesthesiology
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Science, Medicine, and the Anesthesiologist
Key Papers from the Most Recent Literature Relevant to Anesthesiologists (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Anesthesia without Surgery: Unconsciousness is Metastable
Complex Information for Anesthesiologists Presented Quickly and Clearly (Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Instructions for Obtaining A nesthesiology Continuing Medical Education (CME) Credit
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Advertising Abbott ’s Pentothal from Antarctica to Toledo: A Bolus for Bowlus?
Following Army service as a 23rd Infantry combat medic in the Southern Pacific Theater of World War II, Thomas P. Bowlus (1923 to 2014) earned his A.B. at Michigan State Normal College in 1947, the same year that the Australian National Antarctic Research Expedition (A.N.A.R.E.) launched. After earning his M.D. from the University of Michigan in 1951, Dr. Bowlus returned to his native northwest Ohio for internship and medical practice in Toledo (upper left). A decade later, Abbott, the makers of the Pentothal brand of sodium thiopental, began mass-mailing advertising postcards from exotic locations around the world. The po...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Boston ’s Cushing Webber and the Late Doctor’s Early Use of “Perfectly Safe” Ether
Born in Boothby, Maine, Dr. Cushing Webber began practicing dentistry in Massachusetts in 1844, the year that Dr. Horace Wells demonstrated dental anesthesia with nitrous anesthesia in neighboring Connecticut. After Boston dentist William T. G. Morton demonstrated surgical anesthesia with ether in 1846, Dr. Webber began administering ether anesthetics in his own practice. By 1868 he was advertising his Washington Street dental partnership, with Dr. Charles C. Twichell, in the Boston directory. A compulsive and cautious dentist-anesthetist, Dr. Webber advertised on his business card (top, from the Wood Library-Museum &rsquo...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

France ’s Daniel Bovet and Gallamine, the First Synthetic Nondepolarizing Muscle Relaxant Used Clinically
A Swiss-born Italian pharmacologist, Daniel Bovet (1907 to 1992,right) was a research scientist famous for discovering the first antihistamine (1937) and for synthesizing (1947) gallamine, a reversible nondepolarizing muscle relaxant. Named by the multilingual Bovet after France (Latin:Gallia), gallamine was synthesized in Paris by Bovet as a bulky trisquaternary curariform compound. Ironically, high doses of gallamine triethiodide (boxed and branded as Flaxedil,left) released histamine, which Bovet had researched previously. His success with gallamine contributed to Bovet ’s forsaking his 18-yr career at the celebra...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Reverend James B. Dunn ’s Memorial Sermon for Sir James Y. Simpson: A Quarter for the Eulogy?
The professor of midwifery at the University of Edinburgh, Scotland, Sir James Young Simpson (1811 to 1870) passed away at 58 yr of age. His family was immediately extended the honor of his burial at Westminster Abbey, but they graciously declined. The day of Simpson ’s funeral was declared a memorial holiday in Scotland. More than 100,000 grateful citizens and visitors lined the streets of Edinburgh to witness Simpson’s funeral procession and to pay respect to the man who had introduced chloroform anesthesia. In memory of Simpson, the Gynaecological Society of Boston (right) asked Reverend James B. Dunn to del...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Not Electric, Not Eclectic, But Eclectric Oil and Dr. Thomas ’s “Trial by Jury”
One of the stranger annals of pain management involved “Eclectric Oil.” Although advertisements for this nostrum appeared as early as 1858, the name of New York’s Dr. S. N. Thomas (upper left andright) was associated with the oil by 1876. Americans ’ fascination with electricity and their romance with back-to-nature versions of medical practice resulted in a portmanteau of “electric” + “eclectic,” yielding “eclectric.” Eclectric Oil was an eclectic combination of alcohol, chloroform, camphor, and balsam fir with the tinctures of opium, guaiac, and catechu, as well...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Flowers on Dr. B. H. Pearce ’s Trade Card—Were Poppies in His Nitrous Oxide?
Barnum Herbert Pearce (1869 to 1952) learned that his hometown dentist had added a weak elixir of opium poppies to prolong the effects of nitrous oxide. This effort either anticipated or mimicked the early version of “Vegetable Vapor” patented by a Boston dentist. Pearce earned his D.D.S. in 1894 not in his native Ohio, but to the northwest, at the dental department of the University of Michigan. From there he moved east to Pennsylvania, and eventually set up a George Street office in the city of York, as a branch of the “Philadelphia Dental Parlors.” One of Dr. Pearce’s trade cards (above) de...
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Ultrasound-guided Popliteal Intraneural Approach: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Ultrasound-guided Popliteal Intraneural Approach: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Supraclav Suprascap Interscalene Shoulder Surgery: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Supraclav Suprascap Interscalene Shoulder Surgery: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Hospital-level Neuraxial Use in Orthopedics: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Hospital-level Neuraxial Use in Orthopedics: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Intubation in Operating Room versus Intensive Care: Comment
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Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Intubation in Operating Room versus Intensive Care: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Maintenance of Certification: Comment
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research

Maintenance of Certification: Reply
(Source: Anesthesiology)
Source: Anesthesiology - May 15, 2019 Category: Anesthesiology Source Type: research